Lena Lipskaya-Velikovsky

Sensory modulation and daily-life participation in people with schizophrenia.

Schizophrenia is considered to be an extreme mental health disturbance that affects a persons well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. The participation restrictions of people with schizophrenia have been widely investigated through different factors, such as illness symptoms and course, cognition, and demographic data; however, the resulting explanations were incomplete. The purpose of the study was to explore the contribution of sensory modulation (SM), in addition to cognition and schizophrenia symptoms, to participation in daily life activities of people with schizophrenia. Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results indicate significant differences between the study groups in most measurements addressed: participation (diversity and satisfaction), sensory modulation scores (intensity of the response and frequency of response), and cognitive measurements. The most contributive parameters for the prediction of participation dimensions among people with schizophrenia were negative symptoms severity and general cognitive status. In conclusion, people with schizophrenia experience SM disorder with an under responsive tendency. However the complex condition of schizophrenia dominates its influence on participation dimensions.

Car driving in schizophrenia: can visual memory and organization make a difference?

Abstract Purpose: Driving is a meaningful occupation which is ascribed to functional independence in schizophrenia. Although it is estimated that individuals with schizophrenia have two times more traffic accidents, little research has been done in this field. Present research explores differences in mental status, visual working memory and visual organization between drivers and non-drivers with schizophrenia in comparison to healthy drivers. Methods: There were three groups in the study: 20 drivers with schizophrenia, 20 non-driving individuals with schizophrenia and 20 drivers without schizophrenia (DWS). Visual perception was measured with Rey-Osterrieth Complex Figure test and a general cognitive status with Mini-Mental State Examination. Results: The general cognitive status predicted actual driving situation in people with schizophrenia. No statistically significant differences were found between driving and non-driving persons with schizophrenia on any of the visual parameters tested, although these abilities were significantly lower than those of DWS. Conclusion: The research demonstrates that impairment of visual abilities does not prevent people with schizophrenia from driving and emphasizes the importance of general cognitive status for complex and multidimensional everyday tasks. The findings support the need for further investigation in the field of car driving for this population – a move that will considerably contribute to the participation and well-being. Implication for Rehabilitation Unique approach for driving evaluation in schizophrenia should be designed since direct applications of knowledge and practice acquired from other populations are not reliable. This research demonstrates that visual perception deficits in schizophrenia do not prevent clients from driving, and general cognitive status appeared to be a valid determinant for actual driving. We recommended usage of a general test of cognition such as Mini-Mental State Examination, or conjunction number of cognitive factors such as executive functions (e.g. Trail Making Test) and attention (e.g. Continuous Performance Test) in addition to spatial-visual ability tests (e.g. Rey-Osterrieth Complex Figure test) for considering driving status in schizophrenia.

Participation in daily life of people with schizophrenia in comparison to the general population Comparaison de la participation à la vie quotidienne des personnes atteintes de schizophrénie à celle de la population générale

Background. Participation in occupations is a basic human right. Although people with schizophrenia commonly experience restrictions in participation, there is a paucity of research in this area. Purpose. This study aimed to compare the participation patterns of people with schizophrenia to people without mental illness (control group). Method. A total of 140 people of similar age and sex completed the Adults Subjective Assessment of Participation and provided demographic and health-related data. Findings. People with schizophrenia tend to participate in fewer activities and to participate alone. However, they participate with similar intensity as those in the control group. Implications. The participation patterns of people with schizophrenia are both unique and similar to those of the general population. The differences in participation raise concerns due to signs of restriction and social exclusion. However, it appears that people with schizophrenia benefit from occupation and community-based services that promote and support participation with others in diverse activities.

Problem-based learning in occupational therapy curriculum – implications and challenges

Abstract Purpose: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University’s occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies. Method: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students’ grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor’s evaluation and a written assignment). Results: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades. Conclusions: Findings imply partial congruence between students’ grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program. Implications for Rehabilitation Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups. PBL studies have the potential to prepare students for their clinical experience during studies. The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.

Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization.

Abstract Purpose: Participation in day-to-day activities of people with schizophrenia is restricted, causing concern to them, their families, service providers and the communities at large. Participation is a significant component of health and recovery; however, factors predicting participation are still not well established. This study examines whether the parameters obtained during acute hospitalization can predict the intensity and diversity of participation in day-to-day activities six months after discharge. Method: In-patients with chronic schizophrenia (N = 104) were enrolled into the study and assessed for cognitive functioning, functional capacity in instrumental activities of daily living (IADL), and symptoms. Six months after discharge, the intensity and diversity of participation in day-to-day activities were evaluated (N = 70). Results: Multiple correlations were found between parameters obtained during hospitalization and participation diversity, but not participation intensity. The model that is better suited to the prediction of participation diversity contains cognitive ability of construction, negative symptoms and number of previous hospitalizations. The total explained variance is 37.8% (F3,66 = 14.99, p < 0.001). Conclusions: This study provides evidence for ecological validity of the in-patient evaluation process for the prediction of participation diversity in day-to-day activities six months after discharge. Participation diversity is best predicted through a set of factors reflecting personal and environmental indicators. Implications for rehabilitation Results of in-patient evaluations can predict the diversity of participation in day-to-day activities six months after discharge. Higher prediction of participation diversity is obtained using a holistic evaluation model that includes assessments for cognitive abilities, negative symptoms severity and number of hospitalizations.

From hospital admission to independent living: is prediction possible?

An integral component of recovery from mental illness is being able to engage in everyday activities. This ability is often restricted among people with schizophrenia. Although functional deficits are addressed during hospitalization, the ability to predict daily functioning based on information gathered during hospitalization has not been well established. This study examines whether measurements completed during hospitalization can be useful for predicting independent living within the community. Inpatients with schizophrenia (N=104) were enrolled in the study and assessed for cognitive functioning, functional capacity and symptoms. They were approached again 6 months after discharge to evaluate their functioning with respect to everyday life Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Functional capacity during hospitalization predicted 26.8% of ADL functioning and 38.8% of IADL functioning. ADL was best predicted by the severity of negative symptoms, cognitive functioning, and the number of hospitalizations (51.2%), while IADL was best predicted by functional capacity, cognition, and number of hospitalizations (60.1%). This study provides evidence that evaluations during hospitalization can be effective, and demonstrates the advantage of a holistic approach in predicting daily functioning. When a holistic approach is not practical, a functional capacity measurement may serve as an effective predictor.

Motor skills, cognition, and work performance of people with severe mental illness

Abstract Purpose: Employment offers many benefits to people with mental illness, yet their employment rate is much lower than that of the general population. We investigated the effect of work-related motor skills, neurocognition, and job attitudes on the work performance of people with mental illness, comparing those working in sheltered workshops, with controls working in similar jobs. Methods: Twenty-nine adults with severe mental illness and 27 controls matched by gender and age were enrolled into the study using convenience sampling. They were assessed for gross and fine motor hand functioning, job attitudes, work performance, and cognition. Results: People with mental illness scored lower on work performance, cognitive functioning, and hand dexterity while sitting and working with tools. They were assigned lower job loads than were controls, and perceived the physical environment at work as more constraining than did controls. Assembling motor skills significantly explained the work performance of people with mental illness. Conclusions: The results expand our understanding of the complexities involved in the employment of people with severe mental illness, and point to new paths for improving vocational outcomes of people with severe mental illness, taking into account their motor skills and job attitudes. Implications for rehabilitation Therapists should be aware that employed people with severe mental illness may have various unmet needs, affecting their work performance and experience of stress. This study results demonstrate importance of motor skills and perception of the work environment for the promotion of vocational outcomes among individuals with severe mental illness. Employment of people with severe mental illness should be viewed from holistic perspective as with general population, rather than focused on traditionally illness-related factors.

Sensory Modulation and Daily-life Participation in People with Schizophrenia

Introduction Schizophrenia is an extreme mental health disturbance that affects person’s well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. Participation restrictions of people with schizophrenia have been widely investigated through illness symptoms, cognition, and demographic data; however, the resulting explanations were incomplete. Recent studies suggest occurrence of sensory modulation (SM) disorder in schizophrenia that was found affecting everyday participation in other populations. Objectives The study objectives were exploration of SM patterns of people with schizophrenia and their impact on participation in daily life. Aims The study aimed to compare SM patterns in schizophrenia to healthy population and to investigate their contribution to participation in everyday activities in addition to cognition and schizophrenia symptoms. Methods Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results Results indicate significant differences between the study groups in most measurements addressed: participation (diversity: t79=-6.5, p Conclusion People with schizophrenia experience SM disorder with an under responsive tendency. However, the complex condition of schizophrenia dominates its influence on participation dimensions.

Context and psychosocial intervention in mental health

Abstract Objective: Occupational therapy (OT) services have been provided for people with mental health conditions since the foundation of the profession, but OT practices are not clearly outlined. This paper presents the standard OT practices performed in the mental health area. The aim of the study is to quantitatively characterize domains of OT intervention in mental health. Specifically, OT intervention in community and inpatient-based mental health settings is described, further delineated by age groups and gender. Eighteen occupational therapists (OTs), who work in the area of mental health, participated in the study. Each OT had at least two years of experience, was between the ages of 26 and 40, and documented 2–4 treatment sessions. In total, 70 treatment sessions were recorded; half were recorded in hospitals and the majority of recorded sessions involved clients diagnosed with schizophrenia (n = 47). Significant differences were found in the intervention provided in the different settings. In addition, the intervention focus for men and women, and for age groups, was different. Despite these differences, many aspects of the intervention were similar in all contexts. The study results support previous notions that context influences intervention.